FOR SCRIPT ONLINE - compounding self assessment.docx - pharmacy ca 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering your pharmacy name and address in the designated fields at the top of the form.
3. Fill in your contact information, including phone and fax numbers, ensuring accuracy for future correspondence.
4. Select the ownership type of your pharmacy by checking the appropriate box. If 'Other', please specify.
5. Complete sections regarding licensing details, including license numbers and expiration dates as required.
6. List all pharmacy staff involved in compounding duties, ensuring to include their RPH or APH numbers and expiration dates.
7. Proceed through each section of the self-assessment, marking 'Yes', 'No', or 'N/A' as applicable. If you select 'No', provide corrective action plans where indicated.
8. Review all entries for completeness and accuracy before saving or printing your completed assessment for records.

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